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X. MRCS: Anatomy > Neuroanatomy & Pathophysiology > Flashcards

Neuroanatomy & Pathophysiology Flashcards

1
Q

Descending motor tracts

A

Pyramidal:
Corticospinal
Corticobulbar

Extrapyramidal: 
Vestibulospinal
Reticulospinal
Rubrospinal
Tectospinal
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2
Q

Ascending sensory pathways

A

Dorsal column-medial leminiscal pathway

Spinothalamic pathway

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3
Q

Corticospinal tract

A

Somatic motor function
UMN: Primary motor cortex –> internal capsule –> Crus cerebri (brain stem) –> Decussation in high spinal cord –> descends in corticospinal tracts –> ventral horn of spinal cord –> synapse
LMN: ventral horn –> ventral spinal nerve –> target muscle

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4
Q

Dorsal Column

A

Vibration, proprioception, light touch
1st order neurone: sensory organ –> dorsal spinal nerve –> dorsal horn –> ipsilateral dorsal column –> (fasciculus gracilis: LL, fasciculus cuneatus: UL) –> nucleus gracilis/cuneatus (in medulla) –> synapse
2nd order neurone: –> medial leminiscal –> thalamus (ventral posterior lateral nucleus) –> synapse
3rd order: –> somatosensory cortex

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5
Q

Spinothalamic tract

A

Pain, temperature
1st order neurone: sensory organ –> dorsal spinal nerve –> dorsal horn –> synapse
2nd order neurone: –> decussation –> spinothalamic tract –> thalamus –> synapse
3rd order neurone: –> primary somatosensory cortex

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6
Q

Corticobulbar

A

UMN: Primary motor cortex –> internal capsule –> crus cerebri –> exits at appropriate level of brainstem –> synapse
LMN: cranial nerve

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7
Q

Brown-Sequard Syndrome

A

Ipsilateral loss of:
Motor (corticospinal tract)
Vibration, position, light touch (dorsal column)

Contralateral loss of:
Pain, temp (Spinothalamic tract)

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8
Q

Anterior cord syndrome

A 
Caused by disruption of anterior spinal artery
Loss of:
Motor function (corticospinal tracts)
Pain, temp (spinothalamic)
Autonomic dysfunction: low BP

Retained:
Vibration, position, light touch (dorsal column)

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9
Q

Central cord syndrome

A

Loss of:

Motor (Corticospinal tract)

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10
Q

UMN signs

A 
Increased tone
Increased reflexes
Babinski +ve
Clonus
Weakness
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11
Q

LMN signs

A 
Decreased tone
Decreased reflexes
Weakness/flaccid paralysis
Fasciculations
Atrophy
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12
Q

Components of neurone

A

Cell body
Dendrites
Axon
Axon terminal (synaptic terminal)

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13
Q

Cell body of neurone

A

Holds nucleus

Many neural bodies grouped together:
CNS: nucleus
PNS: ganglion

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14
Q

Axon of neurone

A

Long thin structure which carries action potentials
Coated in myelin. Formed by cells wrapping around axon. CNS: oligodendrocyte cells. PNS: Schwann cells.
Gaps in myelin known as nodes of Ranvier

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15
Q

Structure of nerves

A

Nerve is group of fascicles

Fascicle is group of neurones

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16
Q

Coverings of neurones

A

Endoneurium (covers axon)
Perineurium (surrounds fascicle)
Epineurium (surrounds entire nerve)

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17
Q

Resting membrane potential

A

-50 to -75mV
Extracellular: high Na+ and Cl-
Intracellular: high K+
Na/K ATPase maintains gradients (3 Na for 2 K)

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18
Q

Action potential: stages

A 
Stimulus
Depolarisation
Repolarisation
Refractory period
Resting state
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19
Q

Action potential: Depolarisation

A

Depolarisation of voltage-gated Na channels due to electrical stimulus.
Na ions rush back into cell.
Causes intracellular charge to become more positive

20
Q

Action potential: repolarisation

A

Once cell has depolarisated voltage gated K channels open
K ions move down electrochemical gradient out of cell.
As K+ moves out of cell, membrane potential becomes more negative and starts to approach resting potential

21
Q

Action potential: refractory period

A

Absolute refractory period: Na channels close after action potential
Relative refractory period: Na channels slowly come out of inactivation. Neurone can be excited with stimuli stronger than one normally needed.

22
Q

Propagation of action potentials

A

Nodes of Ranvier have high density of ion channels
Myelinated axons have increases membrane resistance and lower membrane capacitance
Electrical signals are conducted from one node to the next, called saltatory conduction

23
Q

Autonomic Nervous System

A

Sympathetic

Parasympathetic

24
Q

Autonomic: spinal cord distribution

A

SNS: thoracolumbar
PSNS: craniosacral

25
Q

Autonomic: preganglionic neurone

A

SNS: short
PSNS: long

26
Q

Autonomic: Preganglionic neurotransmitter

A

SNS: Acetylcholine
PSNS: Acetylcholine

27
Q

Autonomic: postganglionic neurone

A

SNS: long
PSNS: short

28
Q

Autonomic: postganglionic neurotransmitter

A

SNS: Noradrenaline (Ach: sweat/chromaffin cells of adrenal medulla)
PSNS: Acetylcholine

29
Q

Sympathetic nervous system

A 
Spinal compents: T1-L2
Sympathetic chain: "Paravertebral" ganglia 
4 neurones:
Ascending/descending
Post-ganglionic splanchnic
Pre-ganglionic splanchnic
Spinal nerves
30
Q

SNS: ascending/descending

A

Pre-ganglionic: Lateral horn of spinal cord –> ventral root –> white ramus communicans –> sympathetic ganglion –> ascend –> synapse
Post-ganglionic: –> grey ramus communicans –> spinal nerve –> target organ

e.g. Head and neck, lower abdomen/pelvic viscera

31
Q

SNS: post-ganglionic splanchnic

A

Pre-ganglionic: Lateral horn of spinal cord –> ventral root –> white ramus communicans –> sympathetic ganglion –> synapse
Post-ganglionic: –> leaves directly

e.g. cardiopulmonary splanchnics

32
Q

SNS: pre-ganglionic nerve

A

Pre-ganglionic: Lateral horn of spinal cord –> ventral root –> white ramus communicans –> sympathetic ganglion (does not synapse) –> peripheral ganglion –> synapse
Post-ganglionic: nerve –> target organ

E.g. Abdominopelvic splanchnic Celiac ganglion, superior mesenteric ganglion, artorenal ganglion, inferior mesenteric ganglion, superior hypogastric ganglion, inferior hypogastric ganglion

33
Q

SNS: travel with spinal nerve

A

Pre-ganglionic: Lateral horn of spinal cord –> ventral root –> white ramus communicans –> sympathetic ganglion –> synapse
Post-ganglionic: –> grey ramus communicans –> spinal nerve –> target organ

E.g. supply to skin

34
Q

PSNS: cranial origins, ganglions, effects

A

CN: III, VII, IX, X
CNIII: Edinger-Westphal nucleus (midbrain) –> ciliary ganglion: pupil constriction

CNVII:
superior salivary nuclei (pons) –> greater petrosal nerve –> pterygopalatine ganglion: secretomotor (lacrimal, nasal, palatine)
chorda tympani –> submandibular ganglion: secretomotor (submandibular, sublingual)

CNIX: inferior salivary nuclei (medulla) –> lesser petrosal –> otic ganglion: secretomotor (parotid)

CNX: dorsal motor nucleus –> plexuses
Cardiac plexus
Pulmonary plexus
Myenteric plexus (Meissner’s, Auerbach’s)

35
Q

PSNS: sacral component

A

S2-4. Pelvic splanchnic nerves.

36
Q

Meninges

A

Superficial to deep:
Dura mater
Arachnoid mater
Pia mater

37
Q

Dura mater

A

Outermost
2 layers:
Periosteal layer (inner surface of bones on cranium
Meningeal layer (continuous with dura mater)

38
Q

Dura mater: blood supply/drainage

A

Blood supply: middle meningeal artery (branch off maxillary, from external carotid), enters via foramen spinosum

Dural venous sinuses (between layers of dura mater) drain into internal jugular vein

39
Q

Dura mater: dural reflections

A 
Folds inwards to form 4 dural reflections
Falx cerebri (separates L & R cerebral hemispheres)
Tentorium cerebelli (separates occipital lobes from cerebellum, contains tentorial notch)
Falx cerebelli (seperates R & L cerebellar hemispheres)
Daiphagma sellae (covers hypophyseal fossa of sphenoid bone
40
Q

Arachnoid mater

A

Middle layer of meninges
Avascular.
Sub-arachnoid space beneath contains CSF
Arachnoid granulations: Small projections of arachnoid mater into dura allow CSF to enter circulation via dural venous sinuses

41
Q

Pia mater

A

Deepest layer.
Thin, tightly adhered to the brain and spinal cord. Only covering to follow contours of brain.
Highly vascularised with vessels perforating through membrane

42
Q

Traumatic brain injuries

A 
Extradural 
Subdural
Subarachnoid
Cerebral contusion
Intra-cerebral haemorrhage
Diffuse axonal injury
43
Q

Extradural haemorrhage

A

Bleeding between dura and skull
2% of head injuries. 20-30 years. M>F.
Blunt force with linear skull fracture. Parietotemporal fractures most common.
Middle meningeal artery most common due to fracture at pterion.
Sx: Initial LOC. Lucid period. Further deterioration. Headache, nausea, low GCS.
CT: hyperdense biconvex (due to dura’s firm attachments to suture lines.
Rx: >30cm3: surgical. <30cm3 with no red flags: conservative

44
Q

Subdural haemorrhage

A

Bleeding under dural. Between dural and arachnoid: subdural space.
Tearing of bridging veins, vulnerable to decelerating injuries.
RFs: increasing age, ETOH, epileptics, anticoag
Sx: low GCS, headache, focal neurology. Chronic: weeks to present.
CT: crescent-shaped collection. diffusely hyper dense: acute. hypodense: chronic
Rx: trauma craniotomy/burr hole craniotomy

45
Q

Subarachnoid haemorrhage

A

Bleeding into space between arachnoid and Pia mater: subarachnoid space
Spontanous (85% cerebral aneurysm) or traumatic.
Sx: thunderclap headache, meningism
CT: hyper attenuating material seen in subarachnoid space
LP: elevated oxyhemoglobin/bilirubin
Rx: nimodipine (CCB), neurosurgical intervention: coiling/clipping aneurysm

X. MRCS: Anatomy (18 decks)

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